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Short-Course Antibiotic Therapy for Right-Sided Endocarditis Caused by Staphylococcus aureus in Injection Drug Users

Mark J. DiNubile, MD
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From Cooper Hospital University Medical Center, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden, New Jersey. Requests for Reprints: Mark DiNubile, MD, Division of Infectious Diseases, Room 274, Education and Research Building, 401 Haddon Avenue, Camden, New Jersey 08103. Acknowledgments: The author thanks Dr. F. Javier Esteva Lorenzo for his scrutiny of the report published in Spanish (reference 20), Dr. Roseann Lorenick for her review of the manuscript, and Marie Rowland for her assistance in preparing the manuscript.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(11):873-876. doi:10.7326/0003-4819-121-11-199412010-00009
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Right-sided endocarditis caused by Staphylococcus aureus is a frequent complication of injection drug use. Fortunately, the prognosis for this infection when treated with the standard regimen of 4 to 6 weeks of parenteral antistaphylococcal antibiotics is favorable. Nevertheless, in many cases, once drug users feel better, they leave the hospital against medical advice before completing the full course of antibiotic therapy. This problem has stimulated interest in shortening the duration of antibiotic treatment by adding an aminoglycoside antibiotic to a penicillinase-resistant penicillin. Data from in vitro synergy studies and animal models of endocarditis suggest that S. aureus can be eradicated more quickly by combination therapy than by monotherapy. Reports of three prospective, nonrandomized clinical trials have been published that support the use of a 2-week course of a penicillinase-resistant penicillin and an aminoglycoside antibiotic to treat uncomplicated, exclusively right-sided endocarditis caused by methicillin-susceptible S. aureus in injection drug users.





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